摘要
目的 探讨接受新辅助化疗联合免疫治疗(nICT)的食管鳞状细胞癌(ESCC)患者获得主要病理缓解(MPR)的相关临床因素,并构建预测模型.方法 收集2020-10-07-2023-07-03山东省肿瘤医院接受nICT治疗的205例ESCC患者临床资料,比较MPR与非MPR患者差异.使用单因素和多因素分析筛选与MPR相关的临床特征和血液参数,进一步构建预测ESCC患者nICT治疗后MPR发生率的列线图,使用C指数、校准曲线和决策曲线(DCA)评估列线图的预测性能和临床净获益率.结果 在205例患者中有102例获得MPR.年龄(OR=4.374,95％CI为1.989～9.617,P＜0.001)、手术间隔时间(OR=13.943,95％CI 为 3.123～62.240,P=0.001)、淋巴细胞计数(OR=0.115,95％CI 为0.046～0.285,P＜0.001)、单核细胞计数(OR=17.263,95％CI 为 1.482～201.154,P=0.023)、血小板计数(OR=1.008,95％CI 为 1.002～1.015,P=0.014)和白蛋白水平(OR=0.799,95％CI 为 0.702～0.909,P=0.001)是 ESCC患者是否获得MPR的独立影响因素.构建的列线图C指数为0.825,校准曲线显示列线图的预测值和实际值有较好的一致性,决策曲线显示在较大范围内能为患者带来临床净获益率.结论 年龄、手术间隔时间、淋巴细胞计数、单核细胞计数、血小板计数和白蛋白水平是ESCC患者接受nICT后获得MPR的影响因素.使用与MPR有关的因素建立并验证了一个能有效预测ESCC患者nICT治疗后能否获得MPR的列线图,可协助临床医生为患者制定个体化治疗决策.
Abstract
Objective To explore the clinical factors associated with major pathological response(MPR)in esophageal squamous cell carcinoma(ESCC)patients receiving neoadjuvant immunochemotherapy(nICT),and to construct a predic-tive model.Methods We collected clinical data of 205 ESCC patients who received nICT treatment at Shandong Cancer Hospital from October 7,2020 to July 3,2023,and compared the differences between MPR and non-MPR patients.Uni-variate and multivariate logistic regression analysis were used to screen out factors related to MPR,and further construct a nomogram to predict the probability of MPR in ESCC patients after nICT.The C-index,calibration curve,and decision curve analysis(DCA)were used to evaluate the predictive performance and the clinical benefits of the nomogram.Results Totally 102 of 205 ESCC patients achieved MPR.Age(OR=4.374,the 95％CI was 1.989-9.617,P＜0.001),sur-gical interval time(OR=13.943,the 95％CI was 3.123-62.240,P=0.001),lymphocyte count(OR=0.115,the 95％CI was 0.046-0.285,P＜0.001),monocyte count(OR=17.263,the 95％CI was 1.482-201.154,P=0.023),plate-let count(OR=1.008,the 95％CI was 1.002-1.015,P=0.014),and albumin level(OR=0.799,the95％CIwas 0.702-0.909,P=0.001)were independent influencing factors of whether ESCC patients obtain MPR.The constructed nomogram had a C-index of 0.825,and the calibration curve showed satisfactory consistency between the pre-dicted values of the nomogram and actual values.The decision curve showed the clinical benefits brought by the nomo-gram to patients over an extensive range.Conclusions Age,surgical interval time,lymphocyte count,monocyte count,platelet count,and albumin level are the main factors affecting the MPR of ESCC patients after nICT.A nomogram is es-tablished and validated by using factors associated with MPR to effectively predict whether ESCC patients can obtain MPR after nICT,which can assist clinical doctors in making individualized treatment decisions for patients.
基金项目
山东省自然科学基金(ZR2022ZD31)
山东省自然科学基金(ZR2022QH121)
山东省重点研发计划(2021LCZX04)
2021年度山东省医学会临床科研资金——齐鲁专项(YXH2022DZX02002)
山东第一医科大学学术提升计划(2019LJ004)
NETL
NSTL
万方数据